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Introduction
School refusal is a school attendance problem commonly associated with anxiety (e.g. Egger, Costello and Angold, 2003), somatic symptoms (e.g. Bernstein, Massie, Thuras and Perwein, 1997), depression (e.g. Heyne and King, 2004), and low self-efficacy (e.g. Heyne et al., 1998). Reviews of cognitive-behavioural therapy (CBT) for school refusal point to the efficacy of CBT for this problem (Heyne and Sauter, 2012; King and Bernstein, 2001). In addition, Silverman and colleagues' (Silverman, Pina and Viswesvaran, 2008) review of psychosocial treatments for anxiety disorders indicated that CBT for school refusal can be regarded as "possibly efficacious" (p. 109). At the same time, about one-third to one-half of anxious school refusers show little or no response to CBT (Heyne, Sauter, van Widenfelt, Vermeiren and Westenberg, 2011; Heyne et al., 2002; King et al., 1998; Last, Hansen and Franco, 1998), signaling the need for improved treatment. Efforts to improve CBT for youth warrant investigation of the mediators of treatment outcome (Chu and Harrison, 2007; Holmbeck, 1997; Hudson, 2005; Kazdin and Nock, 2003; Prins and Ollendick, 2003; Weersing and Weisz, 2002). Knowledge of the variables that mediate the effects of CBT facilitates the identification of effective treatment components. In turn, knowledge of effective components informs adaptations to CBT and facilitates the dissemination of key components to clinical practice.
Cognition is hypothesized to be involved in the development and maintenance of school refusal (Heyne, 2006; Heyne et al., 1998; Mansdorf and Lukens, 1987; Maric, Heyne, de Heus, van Widenfelt and Westenberg, 2011; McNamara, 1988; Okuyama, Okada, Kuribayashi and Kaneko, 1999; Place, Hulsmeier, Davis and Taylor, 2000, 2002) and it is thus a prime candidate for studying mediation of CBT outcome. Self-efficacy, referring to a person's beliefs about their capacity to perform well in certain situations (Bandura, 1994), is a cognitive construct that has received attention in the school refusal literature. There have been various accounts of school refusers underestimating their ability to cope with anxiety-provoking situations such as handling peers' questions about absence from school or being separated from parents (Heyne, 2006; Heyne et al., 1998; Heyne and King, 2004; Place et al., 2000, 2002). Related, self-efficacy is regarded as a key target in CBT for school refusal (Heyne and Rollings, 2002; Kearney and...